Provider Demographics
NPI:1437361177
Name:KENNETH SHELTON, DC, INC
Entity Type:Organization
Organization Name:KENNETH SHELTON, DC, INC
Other - Org Name:ROSSFORD CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRUSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-666-1114
Mailing Address - Street 1:1114 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1337
Mailing Address - Country:US
Mailing Address - Phone:419-666-1114
Mailing Address - Fax:419-666-6433
Practice Address - Street 1:1114 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1337
Practice Address - Country:US
Practice Address - Phone:419-666-1114
Practice Address - Fax:419-666-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH293447595-00OtherBUREAU WORKERS COMP SSN
OH=========-00OtherBUREAU WORKERS COMP
OH293447595-00OtherBUREAU WORKERS COMP SSN
OH0573971Medicare ID - Type Unspecified